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Does Atrovent HFA (ipratropium bromide) cause side effects?
Atrovent HFA (ipratropium bromide) is a bronchodilator that dilates (enlarges) airways (bronchi) in the lungs. It is used in treating symptoms of asthma, colds, allergies, and chronic obstructive pulmonary disease (COPD) due to emphysema or chronic bronchitis.
Atrovent HFA blocks the effect of acetylcholine on airways (bronchi) and nasal passages. Acetylcholine is a chemical that nerves use to communicate with muscle cells.
In asthma and chronic obstructive pulmonary disease, cholinergic nerves going to the lungs cause narrowing of the airways by stimulating muscles surrounding the airways to contract. The "anti-cholinergic" effect of Atrovent HFA blocks the effect of cholinergic nerves, causing the muscles to relax and airways to dilate.
Mucus glands in the nose also are controlled by nerves that use acetylcholine to communicate. By blocking acetylcholine, Atrovent HFA helps relieve symptoms of allergies and the common cold by preventing secretion of mucus by mucus glands in the nose. When inhaled, Atrovent HFA travels directly to airways, and very little is absorbed into the body.
Common side effects of Atrovent HFA include
Serious side effects of Atrovent HFA include
- bronchospasms that can be life-threatening,
- itching, or
- serious allergic reactions involving closure of the airways, and may worsen symptoms of benign prostatic hyperplasia and narrow-angle glaucoma.
There have been no studies of Atrovent HFA in humans during pregnancy.
It is unknown if Atrovent HFA is secreted in breast milk. Other medications in the same class of drugs are secreted into breast milk. It is unknown if the small amounts that may appear in the milk are of any consequence to the infant. Consult your doctor before breastfeeding.
What are the important side effects of Atrovent HFA (ipratropium bromide)?
The most common side effects associated with ipratropium are:
Because of its anticholinergic effect it may worsen symptoms of benign prostatic hyperplasia and narrow-angle glaucoma.
Atrovent HFA (ipratropium bromide) side effects list for healthcare professionals
The following adverse reactions are described, or described in greater detail, in other sections:
- Hypersensitivity reactions, including anaphylaxis
- Paradoxical bronchospasm
- Ocular effects
- Urinary retention
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in patients.
Clinical Trials Experience
The adverse reaction information concerning Atrovent HFA is derived from two 12-week, double-blind, parallel group studies and one 1-year open-label, parallel group study. These studies compared Atrovent HFA Inhalation Aerosol, Atrovent CFC Inhalation Aerosol, and placebo (in one study only) in 1010 COPD patients.
The following table lists the incidence of adverse reactions that occurred at a rate of greater than or equal to 3% in any ipratropium bromide group and greater than placebo in the 12-week study. The frequency of corresponding reactions in the 1-year open label study is included for comparison.
TABLE 1 : Adverse Reactions (% Patients) in Atrovent HFA
|Placebo-controlled 12 week Study 244.1405 and Active-controlled 12 week Study 244.1408||Active-controlled 1-year Study 244.2453|
|BODY AS A WHOLE - GENERAL DISORDERS|
|CENTRAL & PERIPHERAL NERVOUS SYSTEM DISORDERS|
|GASTROINTESTINAL SYSTEM DISORDERS|
|RESPIRATORY SYSTEM DISORDERS|
|URINARY SYSTEM DISORDERS|
|Urinary tract infection||2||3||1||10||8|
- Cough, rhinitis, and upper respiratory infection occurred in greater than or equal to 3% of patients in either ipratropium treatment group but not greater than placebo in the 12-week study.
- In the one open label controlled study in 456 COPD patients, the overall incidence of adverse events was also similar between Atrovent HFA and Atrovent CFC formulations.
- Overall, in the above mentioned studies, 9.3% of the patients taking 42 mcg Atrovent HFA and 8.7% of the patients taking 42 mcg Atrovent CFC reported at least one adverse event that was considered by the investigator to be related to the study drug. The most common drug-related adverse events were dry mouth (1.6% of Atrovent HFA and 0.9% of Atrovent CFC patients), and taste perversion (bitter taste) (0.9% of Atrovent HFA and 0.3% of Atrovent CFC patients).
- As an anticholinergic drug, cases of precipitation or worsening of narrow-angle glaucoma, glaucoma, halo vision, conjunctival hyperaemia, corneal edema, mydriasis, acute eye pain, dry throat, hypotension, palpitations, urinary retention, tachycardia, constipation, bronchospasm, including paradoxical bronchospasm have been reported with the use of Atrovent.
- Additional adverse reactions identified for Atrovent seen in clinical trials include throat irritation, stomatitis, mouth edema, and vision blurred.
- Allergic-type reactions such as skin rash, pruritus, angioedema including that of tongue, lips and face, urticaria (including giant urticaria), laryngospasm and anaphylactic reactions have been reported.
- In a 5-year placebo-controlled trial, hospitalizations for supraventricular tachycardia and/or atrial fibrillation occurred with an incidence rate of 0.5% in COPD patients receiving Atrovent CFC.
- In addition to the adverse reactions reported in the controlled clinical trials, adverse reactions have been identified during post approval use of Atrovent.
- Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
- Allergic-type reactions such as skin rash, angioedema including that of tongue, lips and face, urticaria (including giant urticaria), laryngospasm and anaphylactic reactions have been reported, with positive rechallenge in some cases.
- Additionally, urinary retention, mydriasis, gastrointestinal distress (diarrhea, nausea, vomiting), cough and bronchospasm, including paradoxical bronchospasm, hypersensitivity reactions, intraocular pressure increased, accommodation disorder, heart rate increased, pharyngeal edema, and gastrointestinal motility disorders have been reported during the post-marketing period with use of Atrovent.
What drugs interact with Atrovent HFA (ipratropium bromide)?
- Atrovent HFA has been used concomitantly with other drugs, including sympathomimetic bronchodilators, methylxanthines, oral and inhaled steroids commonly used in the treatment of chronic obstructive pulmonary disease.
- With the exception of albuterol, there are no formal studies fully evaluating the interaction effects of Atrovent HFA and these drugs with respect to safety and effectiveness.
- There is potential for an additive interaction with concomitantly used anticholinergic medications.
- Therefore, avoid coadministration of Atrovent HFA with other anticholinergic-containing drugs as this may lead to an increase in anticholinergic adverse effects.
Atrovent HFA (ipratropium bromide) is a bronchodilator that dilates (enlarges) airways (bronchi) in the lungs. It is used in treating symptoms of asthma, colds, allergies, and chronic obstructive pulmonary disease (COPD) due to emphysema or chronic bronchitis. Common side effects of Atrovent HFA include dry mouth, cough, headache, nausea, dizziness, and difficulty breathing. There have been no studies of Atrovent HFA in humans during pregnancy. It is unknown if Atrovent HFA is secreted in breast milk.
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Related Disease Conditions
COPD vs. Asthma (Differences and Similarities)
COPD (chronic obstructive pulmonary disease) and asthma both have common symptoms like coughing, wheezing, shortness of breath, and a tight feeling in the chest. COPD is caused by tobacco smoking, while asthma is caused by your inherited genetic makeup and their interactions with the environment. Risk factors for asthma are obesity, exposure to cigarette smoke (even secondhand smoke), and personal history of hay fever. There is no cure for either disease, but symptoms can be managed with medication. A person with asthma has a better prognosis and life expectancy than someone with COPD.
COPD (Chronic Obstructive Pulmonary Disease)
COPD or chronic obstructive pulmonary disease is a lung condition caused by smoking tobacco, exposure to secondhand smoke, and/or air pollutants. Conditions that accompany COPD include chronic bronchitis, chronic cough, and emphysema. Symptoms of COPD include shortness of breath, wheezing, and chronic cough. Treatment of COPD includes GOLD guidelines, smoking cessation, medications, and surgery. The life expectancy of a person with COPD depends on the stage of the disease.
Asthma is a condition in which hyperreactive airways constrict and result in symptoms like wheezing, coughing, and shortness of breath. Causes of asthma include genetics, environmental factors, personal history of allergies, and other factors. Asthma is diagnosed by a physician based on a patient's family history and results from lung function tests and other exams. Inhaled corticosteroids (ICS) and long-acting bronchodilators (LABAs) are used in the treatment of asthma. Generally, the prognosis for a patient with asthma is good. Exposure to allergens found on farms may protect against asthma symptoms.
Chronic bronchitis is a cough that occurs daily with production of sputum that lasts for at least 3 months, 2 years in a row. Causes of chronic bronchitis include cigarette smoking, inhaled irritants, and underlying disease processes (such as asthma, or congestive heart failure). Symptoms include cough, shortness of breath, and wheezing. Treatments include bronchodilators and steroids. Complications of chronic bronchitis include COPD and emphysema.
Asthma: Over the Counter Treatment
Patients who have infrequent, mild bouts of asthma attacks may use over-the-counter (OTC) medications to treat their asthma symptoms. OTC asthma medicines are limited to epinephrine and ephedrine. These OTC drugs are best used with the guidance of a physician, as there may be side effects and the drugs may not be very effective.
COPD vs. Emphysema
COPD (chronic obstructive pulmonary disease) is the term doctors and other healthcare professionals use to describe a group of serious, progressive (worsens over time), chronic lung diseases that include emphysema, chronic bronchitis, and sometimes asthma. The number one cause of COPD or emphysema, is smoking, and smoking is the third leading cause of death in the US.
There are two types of asthma medications: long-term control with anti-inflammatory drugs and quick relief from bronchodilators. Asthma medicines may be inhaled using a metered-dose inhaler or nebulizer or they may be taken orally. People with high blood pressure, diabetes, thyroid disease, or heart disease shouldn't take OTC asthma drugs like Primatene Mist and Bronkaid.
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COPD (chronic obstructive pulmonary disease) is a group of diseases that cause an inflammatory reaction and irreversible damage in the lungs. The result is obstruction of normal airflow and breathing difficulties. COPD is a lifelong condition with periods of flare ups, and is not curable in any stage of the disease. Emphysema and chronic bronchitis are the most common diseases that make up COPD.
What Are the Four Types of Asthma?
Asthma is a chronic inflammatory disease of the airways (bronchi). Bronchi generally allow for the passage of air in and out of the lungs. In asthma, these airways develop hypersensitivity, inflammation, and narrowing. This causes difficulty in breathing. The four types are mild intermittent, mild persistent, moderate persistent and severe persistent.
Asthma in Children
Asthma in children manifests with symptoms such as coughing and wheezing. Rates of asthma in children are increasing. Asthma in children is usually diagnosed based on the description of symptoms. Lung function tests may also be used. A variety of medications are used for the treatment of childhood asthma.
End-Stage COPD: Signs, Symptoms, and Prognosis
Chronic obstructive pulmonary disease (COPD) is a group of diseases causing an inflammatory reaction and irreversible damage to the lungs. They cause obstruction of airflow and difficulty breathing.
Adult-onset asthma is asthma that is diagnosed in people over 20 years of age. Symptoms include wheezing, coughing, shortness of breath and difficulty breathing. Treatment may involve anti-inflammatory medications or bronchodilators.
Can Asthma Go Away on Its Own?
Asthma is a long-term condition for many people, particularly if it first develops when you're an adult. In children, it sometimes goes away or improves during the teenage years, but can come back later in life.
Occupational asthma is a type of asthma caused by exposure to a substance in the workplace. Symptoms and signs include wheezing, chest tightness, and shortness of breath. The usual treatment for occupational asthma involves removal from exposure and the use of bronchodilators and inhaled anti-inflammatory medicines.
Can People With COPD Get Better?
Chronic obstructive pulmonary disease (COPD) is not curable in any stage of the disease. With early diagnosis and treatment, disease progression and flare-ups can be controlled.
Exercise-induced asthma is asthma triggered by vigorous exercise. Symptoms include coughing, shortness of breath, chest tightness, wheezing, and fatigue while exercising. Preventing exercise-induced asthma attacks involves using inhaled medicines before exercising, performing warm-up exercises and cooling down afterward, avoiding exercising outdoors when pollen counts are high, restricting exercise when you have a viral infection, and wearing a mask over your nose and mouth when exercising in cold weather.
Emphysema, Chronic Bronchitis, and Colds
If you have a COPD such as emphysema, avoiding chronic bronchitis and colds is important to avoid a more severe respiratory infection such as pneumonia. Avoiding cigarette smoking, practice good hygeine, stay away from crowds, and alerting your healthcare provider if you have a sinus infection or cold or cough that becomes worse. Treatment options depend upon the severity of the emphysema, bronchitis, or cold combination.
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Medications & Supplements
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Professional side effects and drug interactions sections courtesy of the U.S. Food and Drug Administration.